OBJECTIVES: Individuals with disabilities are at greater risk of hospitalization than the general population. We examined 10-year trends in potentially preventable hospitalizations (PPH) in Korea, comparing individuals with and without disabilities and assessing age-specific patterns. METHODS: Using National Health Information Database claims data (2010–2019), we established a fixed cohort of newly registered individuals with disabilities and control subjects statistically matched (1:1.5) at baseline. Annual PPH rates among patients with each condition were calculated and age- and sex-standardized according to Organization for Economic Cooperation and Development Health Care Quality Indicators definitions. Trends and annual percent changes (APCs) were analyzed by disability status and age group (non-older: 30–64; older adults: ≥65 years). RESULTS: Between 2010 and 2019, PPH rates declined significantly in both groups. Among individuals with disabilities, the steepest decline was observed for hypertension (APC, −15.7%; 95% confidence interval [CI], −17.7 to −13.7), whereas congestive heart failure showed the largest reduction among individuals without disabilities (APC, −7.8%; 95% CI, −10.8 to −4.7). Declines were generally greater among non-older adults aged 30–64 years, regardless of disability status. The disparity between disability and non-disability groups narrowed over the decade, primarily due to larger improvements among non-older adults. Older adults with disabilities consistently exhibited the highest PPH rates for most conditions, whereas younger individuals with disabilities had the highest rates for diabetes. CONCLUSIONS PPH rates declined over the decade among both individuals with and without disabilities, particularly for hypertension and among non-older adults. However, older adults with disabilities remain at elevated risk, underscoring the need for targeted strategies to improve access to community-based primary care.

PURPOSE: This study sought to investigate the effects of the McKenzie exercise program on forward head posture and respiratory function. METHODS: Thirty adult men and women with forward head posture, aged 20-29 years, were randomly assigned to the experimental group (N=15) or the control group (N=15). Subjects in the experimental group performed the McKenzie exercises three times a week for four weeks, while subjects in the control group did not receive any intervention. Craniovertebral angle (CVA) was measured to quantify forward head posture, and forced vital capacity (FVC), FVC % predicted, forced expiratory volume at one second (FEV1), and FEV1 % predicted were measured to determine changes in respiratory function. The Mann-Whitney U-test was used to analyze pre-test differences in forward head posture and respiratory function between the two groups, and the Wilcoxon signed-rank test was used to analyze differences in forward head posture and respiratory function within the groups before and after intervention. The significance level (α) was set to 0.05. RESULTS: A comparison of pre- and post-test measures showed that CVA significantly increased in the experimental group (p=0.001) denoting postural improvement, whereas no significant difference was found in the control group (p=0.053). All respiratory measures, i.e.,FVC, FVC %pred, FEV₁, and FEV₁ %pred, were significantly improved in the experimental group, whereas there were no significant differences in the control group. CONCLUSION McKenzie exercise can be effective in improving forward head posture and respiratory function.

Arterial dissection is an important cause of stroke. We report two cases of isolated posterior inferior cerebellar artery (PICA) dissection diagnosed by high-resolution vessel-wall MRI (HRVW-MRI). One subject complained of abrupt-onset vertigo and headache, and the other subject had headache, vertigo, and Horner syndrome. Conventional MRA showed only focal dilatation of the PICA, but HRVW-MRI revealed intramural hematoma and double-lumen contour in the PICA, suggesting arterial dissection. We suggest that the use of HRVW-MRI should be considered when diagnosing isolated PICA dissection in a PICA infarct with an unknown cause.
Arteries* ; Dilatation ; Headache ; Hematoma ; Horner Syndrome ; Magnetic Resonance Imaging* ; Pica ; Stroke ; Vertigo

BACKGROUND AND OBJECTIVES: Heart rate variability(HRV) reflects the autonomic integration of heart. There were many reports that HRV in patients with myocardial infarction or heart failure is an independent prognostic factor to predict fatal arrhythmia and sudden cardiac death. But, the role of HRV is still controversial in stable angina patients without history of myocardial infarction. In this study, we tried to compare HRV indices between stable angina patients and normal subjects. MATERIALS AND METHODS: Twenty-one stable anginal patients without history of myocardial infarction (mean age : 57 +/- 2 years) and twenty-one relatively healthy persons without history of coronary heart disease (mean age : 53 +/- 2 years) were included in the study and underwent 24-hour ambulatory ECG monitoring. In patients group, all underwent coronary angiography after 24-hour ambulatory ECG monitoring. HRV was analyzed over the whole 24 hours, using time and frequency domain parameters, according to time phases and coronary angiographic severity. RESULTS: There were no significant differences in age, sex and cardiovascular risk factors, except hypertension (p=.001) between two groups. HRV indices such as rMSSD, pNN50, LF, HF, LFnorm and HFnorm were significantly decreased (p<0.05) in patients group. But the angiographic severity of coronary arteries did not show any significant effect on the HRV indices in patients group. CONCLUSIONS: We observed significantly reduced HRV indices in patients with stable angina without history of myocardial infarction.
Angina, Stable* ; Arrhythmias, Cardiac ; Coronary Angiography ; Coronary Disease ; Coronary Vessels ; Death, Sudden, Cardiac ; Electrocardiography ; Heart Failure ; Heart Rate* ; Heart* ; Humans ; Hypertension ; Myocardial Infarction* ; Risk Factors

BACKGROUND AND OBJECTIVES: akayasu's arteritis is a disease of unknown etiology which has recently been reported to be a systemic disease. This is a prospective study of the clinical features and angiographic findings of Takayasu's arteritis from a single center. SUBJECTS AND METHODS: orty five patients were diagnosed as Takayasu's arteritis according to the Numano's diagnostic criteria, where patients satisfying at least one criterion from elevated ESR or CRP, arterial wall enhancement at MRA or CT angiography, or carotid tenderness are categorized into the active group. A disease duration of one year was used to define the division of the disease into either acute or chronic. Ueno's and Numano's classifications obtained through various imaging studies, were used. RESULTS: t the time of diagnosis, 60% of patients were in the active stage while 40% were in inactive stage. Levels of ESR, CRP and fibrinogen were found to differ significantly according to disease activity. The most common type of Takayasu's arteritis was type III according to the Ueno's classification, and type V according to the Numano's. The left subclavian artery was involved most frequently (78.5%). The most commonly involved segment of the aorta was the abdominal aorta (64.4%). Mean systolic blood pressure of the right arm in the renal artery stenosis group was 156+/-39 mmHg, which was significantly higher than that in the group without renal artery stenosis (113+/-46 mmHg) (p=0.005). ESR and CRP were correlated with aortic signal intensity on contrast-enhanced MR imaging (ESR;r=0.685, p=0.007/CRP;r=0.596, p=0.041). CONCLUSION: akayasu's arteritis is a disease of unknown causes, especially among young female patients, and exhibits nonspecific and various symptoms. ESR and CRP remain as valuable indicators of disease activity. The MR enhancement intensity of the arterial wall shows a positive correlation with both ESR and CRP level and it therefore may be correlated to disease activity and represent a useful diagnostic indicator.
Angiography ; Aorta ; Aorta, Abdominal ; Arm ; Arteritis ; Blood Pressure ; Classification ; Diagnosis ; Female ; Fibrinogen ; Humans ; Magnetic Resonance Imaging ; Prospective Studies ; Renal Artery Obstruction ; Subclavian Artery ; Takayasu Arteritis*

BACKGROUND AND OBJECTIVES: Pulmonary embolism (PE) is a disease with high mortality if left untreated. But, confirmative diagnosis is difficult because many diagnostic modalities are nonspecific. Pulmonary angiography, which is considered as the gold standard diagnostic tool, is invasive, costly, time-consuming, and not always available in small centers. Echocardiography is a non-invasive and available in the emergency room without significant time delay. We investigated the role of echocardiography as a screening test in patients with suspected PE. MATERIALS AND METHODS: (A) Retrospective study: We analyzed the recorded videotapes of transthoracic echocardiography in fifty patients with confirmed PE from Jan 1995 to Aug 1999. From the frequent echocardiographic findings of those patients, positive criteria were defined as followed ( 2 among 1-5 or only 6). (1) RV or pulmonary artery dilatation (RVEDA/LVEDA 0.6) (2) RV hypokinesis (3) paradoxical septal wall motion (4) pulmonary hypertension (5) TR (moderate degree or more) (6) Visible thrombus. Although the degree of TR was less than moderate, if the degree of pulmonary hypertension was more than moderate, we considered as PE. (B) Prospective study: From Nov 1999 to June 2000, patients with suspected pulmonary embolism underwent a transthoracic echocardiography and perfusion-ventilation lung scan or chest CT. We assessed echocardiographic findings, sensitivity and specificity of the previously defined echocardiographic positive criteria for PE. RESULTS: (A) Retrospective study: The sensitivity of echocardiography for PE was 74%. (B) Prospective study: The number of enrolled patients was thirty-four. In twenty patients the diagnosis was PE. The sensitivity of echocardiography was 75% but the specificity was 14%. CONCLUSION: Echocardiography may be used as a good screening test in patients who are clinically suspicious of pulmonary embolism.
Angiography ; Diagnosis ; Dilatation ; Echocardiography* ; Emergency Service, Hospital ; Humans ; Hypertension, Pulmonary ; Lung ; Mass Screening* ; Mortality ; Prospective Studies ; Pulmonary Artery ; Pulmonary Embolism* ; Retrospective Studies ; Sensitivity and Specificity ; Thrombosis ; Tomography, X-Ray Computed ; Videotape Recording

BACKGROUND AND OBJECTIVES: Pulmonary embolism (PE) is a disease with high mortality if left untreated. But, confirmative diagnosis is difficult because many diagnostic modalities are nonspecific. Pulmonary angiography, which is considered as the gold standard diagnostic tool, is invasive, costly, time-consuming, and not always available in small centers. Echocardiography is a non-invasive and available in the emergency room without significant time delay. We investigated the role of echocardiography as a screening test in patients with suspected PE. MATERIALS AND METHODS: (A) Retrospective study: We analyzed the recorded videotapes of transthoracic echocardiography in fifty patients with confirmed PE from Jan 1995 to Aug 1999. From the frequent echocardiographic findings of those patients, positive criteria were defined as followed ( 2 among 1-5 or only 6). (1) RV or pulmonary artery dilatation (RVEDA/LVEDA 0.6) (2) RV hypokinesis (3) paradoxical septal wall motion (4) pulmonary hypertension (5) TR (moderate degree or more) (6) Visible thrombus. Although the degree of TR was less than moderate, if the degree of pulmonary hypertension was more than moderate, we considered as PE. (B) Prospective study: From Nov 1999 to June 2000, patients with suspected pulmonary embolism underwent a transthoracic echocardiography and perfusion-ventilation lung scan or chest CT. We assessed echocardiographic findings, sensitivity and specificity of the previously defined echocardiographic positive criteria for PE. RESULTS: (A) Retrospective study: The sensitivity of echocardiography for PE was 74%. (B) Prospective study: The number of enrolled patients was thirty-four. In twenty patients the diagnosis was PE. The sensitivity of echocardiography was 75% but the specificity was 14%. CONCLUSION: Echocardiography may be used as a good screening test in patients who are clinically suspicious of pulmonary embolism.
Angiography ; Diagnosis ; Dilatation ; Echocardiography* ; Emergency Service, Hospital ; Humans ; Hypertension, Pulmonary ; Lung ; Mass Screening* ; Mortality ; Prospective Studies ; Pulmonary Artery ; Pulmonary Embolism* ; Retrospective Studies ; Sensitivity and Specificity ; Thrombosis ; Tomography, X-Ray Computed ; Videotape Recording